HomeMy WebLinkAbout810322.tiff RESOLUTION
RE: APPROVAL OF 1981 DENTAL CONTRACT BETWEEN THE DEPARTMENT OF
SOCIAL SERVICES AND THE WELD COUNTY DENTAL SOCIETY AND
AUTHORIZATION FOR CHAIRMAN TO SIGN THE SAME.
WHEREAS, the Board of County Commissioners of Weld County,
Colorado, pursuant to Colorado statute and the Weld County Home
Rule Charter, is vested with the authority of administering the
affairs of Weld County, Colorado, and
WHEREAS, the 1981 Dental Contract between the Weld County
Department of Social Services and the Weld County Dental Society
has been prepared and presented to the Board of County Commis-
sioners for approval, and
WHEREAS, the total amount of said Contract shall not
exceed $15,000, and
WHEREAS, the Board of County Commissioners has studied said
Contract and deems it advisable to approve the same.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Com-
missioners of Weld County, Colorado that the 1981 Dental Con-
tract between the Weld County Department of Social Services
and the Weld County Dental Society be, and hereby is , approved.
BE IT FURTHER RESOLVED by the Board of County Commissioners
that the Chairman of the Board be, and hereby is , authorized to
sign said Contract.
The above and foregoing Resolution was, on motion duly made
and seconded, adopted by the following vote on the 28th day of
January, A.D. , 1981.
BOARD OF COUNTY COMMISSIONERS
ATTEST: WELD COUNTY, COLORADO
Weld Couny Clerk and Recorder
and Clerk' to the Boar Chuck Carlson, CChai�rman
uty Count Clerk Norman Carlson, Pro-Tem
APPRO ED AS TO FORM: `11/t.
C W Kirby
/
ounty Attorney tI - zz-
;) ez Zoe'
n T . Martin
'.rine K. St6inmark
8I0322
cl-,r�, . :7 DATE PRESENTED: JANUARY 28, 1981
CONTRACT FOR DENTAL CARE - 1981
THIS AGREEMENT made and entered into this day of
January, 1981, by and between the BOARD OF COUNTY COMMISSIONERS
OF THE COUNTY OF WELD, STATE OF COLORADO, hereinafter referred
to as "County" and THE WELD COUNTY DENTAL SOCIETY, hereinafter
referred to as "Society. "
WITNESSETH:
For and in consideration of the mutual promises and
obligations set forth herein, the parties hereto mutually
agree as follows :
1. Purpose.
The purpose of this Agreement is to set forth the
framework under which the Dental Care Program of
the Weld County Department of Social Services
shall be administered. The sum of $15 , 000. 00 has
been appropriated by County for said program for
calendar year 1981 . It is the mutual agreement
and understanding of the parties hereto that the
total amount to be paid by County during calendar
year 1981 shall not exceed said $15 , 000. 00 and
that when this budgeted amount is depleted, no
provision shall be made for further dental care
services .
Participating dentists , as well as social
services staff, must cooperatively monitor use of
this program in order to utilize the limited funds
effectively and efficiently.
2 . Eligible Recipients .
County shall be responsible for payment for dental
services provided by members of Society to eligible
recipients only after County has verified eligibility
either orally or in writing. Eligibility for such
services under this program shall be within the
sound discretion of the County, but shall be
available only where alternative resources such as
Medicaid, Medicare or Old Age Pension benefits are
not available.
3. Qualifications of Providers .
Only members of Society who are in good standing
in their accredited society and/or Association
shall receive appointments as participating members
of County' s Dental Program.
4. Fees for Services.
A. Fees for services shall be charged by partici-
pating dentists in accordance with the schedule
set forth in Society' s current "Fee Schedule
for County Indigents . " Services shall be
limited to emergency dental care and after
providing dental care relating to an acute
episode , the dentist shall refer the patient
to available federally funded clinics in
order to secure non-emergency care.
B. Prompt billing for completed services is
imperative. No authorization shall be made
for billings which are submitted more than
120 days after the date when the services
were rendered.
C. The maximum coverage under this agreement
shall be the sum of $100 per person per year ,
and the patient shall be responsible for
paying 10% of the billed amount. Any charges
in excess of $100 shall be the sole responsiblity
of the patient. The dentist rendering services
shall be responsible for the collection of
any amounts for which the patient is responsible.
5 , Adjudicating Committee.
A committee consisting of representatives of the
Socity shall recommend policies and initiate
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procedures for this Dental Contract and shall
review the billings and adjudicate, consistent
with this Agreement , any unusual fees . Decisions
of this committee shall be final and binding to
all doctors who participate in this contract. It
is expressly understood, however, that any member
of the Weld County Dental Society may be present
at any meeting of such committee and have full
opportunity to examine the books to see that the
funds are divided fairly and without prejudice
among all participating doctors who have performed
services . The members of this committee act only
as agent for the Society and in no case shall they
be held personably liable for such acts .
6. Submittal of Vouchers .
Vouchers for payment shall be submitted to the
Weld County Dental Society, Welfare Fund Committee,
c/o Dr. James Shaddock, 1648 8th Avenue, Greeley,
Colorado 80631. When submitting vouchers for
payment, members of the Society shall itemize all
costs . Together with the itemized fees for services
and laboratory costs , such statement must show the
recipient ' s name, description of services rendered,
and the amounts paid by the patient . Failure to
comply with these provisions shall result in
disapproval of the charges by the Adjudicating
Committee.
7 . Members of Society Independent Contractors .
It is expressly understood by the parties hereto
that members of the Society are not employees of
County but are independent contractors and shall
be solely responsible for their actions and those
of their employees .
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8. Amendment.
This Agreement may be amended by the parties
hereto at any time, provided such amendment is
reduced to writing , signed by both parties and
incorporated herein as an amendment.
IN WITNESS WHEREOF, the parties hereto have executed
this Agreement on the day and year first above written.
BOARD OF COUNTY COMMISSIONERS
ATTEST: WELD COUNTY, COLORADO
Weld County Clerk and Recorder
a erk to the B and By: (1:7', 4"; 6r , /,
1 Chuck Carlson; Chairman
7B
y: -
,,-
eputy Count er
P V D AS TO FORM: WELD COUNTY DENTAL SOCIETY
C:17±±-&;(16.-Ii- By: 'R,ecl a SO/
U DJs.
County Attorney Presi entO
Chai ian H
WELD COUNTY DEPARTMENT OF SOCIAL
SERVICES
r
By : .e'-C ��"t"C/a /�/�i�.�f%—�
Eugie McKenn /, D_irector
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t . CDS STANDARD TABLE OF VALUES NO. 004
r • (This is not a list of services covered under any program)
DIAGNOSTIC (Film fees include Exam and Diagnosis) PERIODONTICS
I 0160 Office visit for observation and $ 9.00 4210 G ;;givectomy,with pack app c: Lion S 70 CO
treatment of injuries (per quadrant)
9110 Emergency treatment,palliative,per visit 9.03 42 18 Gin-ivecto-my, per tooth (fewer than 5) 16.00
0210 Full mouth series consisting of at least 43-15 Deep calm..g (per quadrant) 1.3.03
14 films(including B/W if indicated) 27.00 4346 Deep scaling ant corretage with root
0220 Single film 4.00 planing (para'aadrant) 32.•1.3
0230 Each additional film,up to 10 2.00
0330 Panoramic film 21.00 PRO.THODONT!CS (Fees include Adjustments
0272 Bite-wing films 9.00 for 3 Months)
0470 Study models 11.00 5110 Fci!upperdanture 3255 .;
5120 Full lower denture 255.00
PREVENTIVE 5231 Lower partial with c'nrc lingua!
1110 Prophylaxis,adult(age 15 and over) $15.00 barandcl ;ps,acrylicba 23 '-.n9
1120 Prophylaxis. children to age 14 11.00 52-11 Lc.,>r partial wit chrcrne li:,_;u;o
1220 Topical application of fluoride bar and clasp_;, c;.;:. h: se 3.00 0;
(excluding prophylaxis) 9.00 5251 U2nar partial viii ::fatal
1515 Fixed,bilateral,band type spacer 5-1.00 b.ar end cl so, ..:vl: 23135_6
. 1510 Fixed,unilateral,band type spacer 37.00 5281 Upoar psrtial witg c'nrospalatal
r.- ,ndct ba.is 291 00
RESTORATIVE 52 .30 • i oast b.; . r H . .r',;I 2 3.5..
2110 Amalgam,one Surface,primary $ 10.00 5:15 D .,tureaD ;our: H ir,cN -•6.G:;
, 2120 Amalgam,twosttirfaces,primary 15.00
2130 Amalgam,threeormoresurfaces,prim. 20.00 DENTURE- (50='LICA'I1 JN A ) ;3502 HNC
2140 Amalgam,one surface,permanent . 11.03 5710 D c<.r,>f I 31 S H2 _.
2150 Amalgam,two surfaces,permanent 18.00 5720 t? ce , . 3201.25 1
2160 Amalgam, three or more surfaces, 573.9 PH- -un ; f.: r• , 13 it ,
permanent 23.00 5743 R -,n,; 1 ,, :,n=`. _. .
2303 Acrylic,silicate.orcomposite,Class III 16.00 5/00 F; ,i g c, ,, 1 ,.. r,-)
2304 Acrylic,silicate,or composite,Class IV 21.50 5703 Nr3 -Iirii. ,5-:,t3,' , ,r t ,: 1
2305 Acrylic,silicate,or composite,Class V 15.00
BRIDGE PONI!CS
CROWNS 0210 C.c/paid 5121 '
2710 Crown,plastic or acrylic $1020') 0225 !;in ;., -, ,:3-i; :5- 1?5 ; 1
2720 Crown,plastic processed to metal 137.['11) 'lair l: ;;'':11, 1.,OCC
2740 Crown.porcelain 1-14 CO .., t-, •, - ;I J7 CD
2750 Crown,porcelain fused to metal 172 00
2790 Cro rn,full,gold,cast 137.09 ORAL SU=. E'7Y (= „,, r :nc,aer Ro, '!e,
2810 Crown,Y4,gold,cast 131.07 P t-Op C_ )
i' 2830 Crown,stainless steel 31.00 1.113 -H pare ,t..:<t - .'! ,n ; 14
2840 Crown,temporary(fractured tooth) 21 r! i 71 I ;ri, ra.,;,on 11.,'1
71 i 7 c. pr:I1 it n 11.0':
ENDODONTICS (Fees include Radiographs) - 7113 F id _,-, p-,,m. x:;ct;or, 3 C;
3110 Direct pulp cap $ 10.00 /210 5; ;, aluxt ict:oso' otodtoc!h 25.00
3220 Vital pulpotomy 10.00 . 7223 r;,cal ectr:ctios. 5O1: iasI'
3310 S.ngie root canal filling 97; cc ir;:' ction 32-0:)
3320 Si-rootcanal filling 123 00 7230 S :r:,:cal c/.:ra:i 93. p'aC,atly :25-3,,,
3330 Tri-rootcanal filling 161 CC i -•, _Clio 45.00
3420 Aoicoectomy, including root canal 7210 u 7.cal aV;r2ctic.n. completely burly
r ii:'r.n.- 118 0 02.
05
/007 it r--,2rao,•ni 21.03
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